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This is VAERS ID 1331130

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1331130
VAERS Form:2
Age:54.0
Sex:Female
Location:New York
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Eye swelling, Muscle spasms, Eye pruritus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: FLU SHOT
Other Medications: CLONIDINE, LABETALOL, DOXAZOSIN, XOLAIR
Current Illness:
Preexisting Conditions: HYPERTENSION, INTERMITTENT ASHTMA, MAST CELL ACTIVATION SYNDROME, IDIOPATHIC ANAPHYLAXIS, CHRONIC IDIOPATHIC URTICARIA, HISTORY OF ALLERGIC REACTIONS, MASTOCYTOSIS
Allergies: PREDNISONE, PEANUTS, FLU VACCINE, ATROVENT, IODINE, ASPIRIN, VANCOMYCIN, MORPHINE, TOMATOES, PINEAPPLE, LATE, POTASSIUM CHLORIDE, SANDIMMUNE, CYCLOSPORINE, CARDIZEM, SHELLFISH, BARIUM, CONTRAST DYES, METOPROLOL, AMLODIPINE, HYDRALAZINE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT RECEIVED VACCINE, AFTER ABOUT 25MINUTES SHE STARTED DEVELOPING SYMPTOMS SUCH AS LEG CRAMPING, EYE SWELLING AND EYE ITCHING SIMILAR TO MAST CELL ACTIVATION FLARES SHE HAS HAD IN THE PAST. SHE DENIED ANY LIP, TONGUE OR THROAT SWELLING AND DENIES ANY WHEEZING OR TROUBLE BREATHING, SHE ALSO DENIES ANY ABDOMINAL PAIN, VOMITING OR DIARRHEA.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1331130&WAYBACKHISTORY=ON


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